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The relationship between tap water and health has been a topic of public concern and calls for better management in Canada since well-publicized contamination events in two provinces (Ontario and Saskatchewan) in 2000–2001. This study reports the perspectives on health risks from tap water and corresponding use of, and spending on, bottled water in a number of different communities in Canada. In 2009–2010, four First Nations communities (three from Ontario and one from Saskatchewan) and a geographically diverse sample of non-First Nations Canadians were surveyed about their beliefs concerning health risks from tap water and their spending practices for bottled water as a substitute. Responses to five identical questions were examined, revealing that survey respondents from Ontario First Nations communities were more likely than non-First Nations Canadians to believe bottled water is safer than tap water (OR 1.6); more likely to report someone became ill from tap water (OR 3.6); more likely to express water and health concerns related to tap water consumption (OR 2.4); and more likely to spend more on bottled water (OR 4.9). On the other hand, participants from one Saskatchewan First Nations community were less likely than non-First Nations Canadians to believe that someone had become ill from drinking tap water (OR 3.8), less likely to believe bottled water is safer than tap (OR 2.0), and less likely to have health concerns with tap water (OR 1.5). These differences, however, did not translate into differences in the likelihood of high bottled water expenditures or being a 100% bottled water consumer. The paper discusses how the differences observed may be related to water supply and regulation, trust, perceived control, cultural background, location, and past experience.

To examine the relationship between chronic training loads, number of exposures to maximal velocity, the distance covered at maximal velocity, percentage of maximal velocity in training and match-play and subsequent injury risk in elite Gaelic footballers. Prospective cohort design. Thirty-seven elite Gaelic footballers from one elite squad were involved in a one-season study. Training and game loads (session-RPE multiplied by duration in min) were recorded in conjunction with external match and training loads (using global positioning system technology) to measure the distance covered at maximal velocity, relative maximal velocity and the number of player exposures to maximal velocity across weekly periods during the season. Lower limb injuries were also recorded. Training load and GPS data were modelled against injury data using logistic regression. Odds ratios (OR) were calculated based on chronic training load status, relative maximal velocity and number of exposures to maximal velocity with these reported against the lowest reference group for these variables. Players who produced over 95% maximal velocity on at least one occasion within training environments had lower risk of injury compared to the reference group of 85% maximal velocity on at least one occasion (OR: 0.12, p=0.001). Higher chronic training loads (≥4750AU) allowed players to tolerate increased distances (between 90 to 120m) and exposures to maximal velocity (between 10 to 15 exposures), with these exposures having a protective effect compared to lower exposures (OR: 0.22 p=0.026) and distance (OR=0.23, p=0.055). Players who had higher chronic training loads (≥4750AU) tolerated increased distances and exposures to maximal velocity when compared to players exposed to low chronic training loads (≤4750AU). Under- and over-exposure of players to maximal velocity events (represented by a U-shaped curve) increased the risk of injury.

Background: Hearing loss is defined as worsening of hearing acuity and is usually expressed as an increase in the hearing threshold. Tinnitus, defined as “ringing in the ear”, is a common and often disturbing accompaniment of hearing loss. Hearing loss and environmental exposures to noise are increasingly recognized health problems. Objectives: The objective was to assess whether the exposure-response relationship can be established between exposures to non-occupational noise and permanent hearing outcomes such as permanent hearing loss and tinnitus. Methods: Information sources: Computer searches of all accessible medical and other databases (PubMed, Web of Science, Scopus) were performed and complemented with manual searches. The search was not limited to a particular time span, except for the effects of personal listening devices (PLDs). The latter was limited to the years 2008–June 2015, since previous knowledge was summarized by SCENIHR descriptive systematic review published in 2008. Study eligibility criteria: The inclusion criteria were as follows: the exposure to noise was measured in sound pressure levels (SPLs) and expressed in individual equivalent decibel values (LEX,8h), the studies included both exposed and reference groups, the outcome was a permanent health effect, i.e., permanent hearing loss assessed with pure-tone audiometry and/or permanent tinnitus assessed with a questionnaire. The eligibility criteria were evaluated by two independent reviewers. Study appraisal and synthesis methods: The risk of bias was assessed for all of the papers using a template for assessment of quality and the risk of bias. The GRADE (grading of recommendations assessment, development, and evaluation) approach was used to assess the overall quality of evidence. Meta-analysis was not possible due to methodological heterogeneity of included studies and the inadequacy of data. Results: Out of 220 references identified, five studies fulfilled the inclusion criteria. All of them were related to the use of PLDs and comprised in total of 1551 teenagers and young adults. Three studies used hearing loss as the outcome and three tinnitus. There was a positive correlation between noise level and hearing loss either at standard or extended high frequencies in all three of the studies on hearing loss. In one study, there was also a positive correlation between the duration of PLD use and hearing loss. There was no association between prolonged listening to loud music through PLDs and tinnitus or the results were contradictory. All of the evidence was of low quality. Limitations: The studies are cross-sectional. No study provides odds ratios of hearing loss by the level of exposure to noise. Conclusions: While using very strict inclusion criteria, there is low quality GRADE evidence that prolonged listening to loud music through PLDs increases the risk of hearing loss and results in worsening standard frequency audiometric thresholds. However, specific threshold analyses focused on stratifying risk according to clearly defined levels of exposure are missing. Future studies are needed to provide actionable guidance for PLDs users. No studies fulfilling the inclusion criteria related to other isolated or combined exposures to environmental noise were identified.

In this article, we propose a generalized estimating equations (GEE) approach for correlated ordinal or nominal multinomial responses using a local odds ratios parameterization. Our motivation lies upon observing that: (i) modeling the dependence between correlated multinomial responses via the local odds ratios is meaningful both for ordinal and nominal response scales and (ii) ordinary GEE methods might not ensure the joint existence of the estimates of the marginal regression parameters and of the dependence structure. To avoid (ii), we treat the so-called \"working\" association vector α as a \"nuisance\" parameter vector that defines the local odds ratios structure at the marginalized contingency tables after tabulating the responses without a covariate adjustment at each time pair. To estimate α and simultaneously approximate adequately possible underlying dependence structures, we employ the family of association models proposed by Goodman. In simulations, the parameter estimators with the proposed GEE method for a marginal cumulative probit model appear to be less biased and more efficient than those with the independence \"working\" model, especially for studies having time-varying covariates and strong correlation.

Background: Several poly ADP ribose polymerase inhibitors (PARPis) are currently approved for the treatment of a variety of cancers. The safety profile of PARPis has not yet been systemically analyzed in the real world. We conducted this pharmacovigilance analysis using the US FDA’s Adverse Event Reporting System (FAERS) database to explore the difference in adverse events (AEs) among PARPis. Method s: FAERS data (December 2014 to October 2021) were searched for reports of all FDA-approved PARPis across all indications. We used the standardized MedDRA query (SMQ) generalized search AEs on the preferred term (PT) level based on case reports. After filtering duplicate reports, disproportionality analysis was used to detect safety signals by calculating reporting odds ratios (ROR). Reports were considered statistically significant if the 95% confidence interval did not contain the null value. Results : Within the standardized MedDRA queries, significant safety signals were found, including those for olaparib [blood premalignant disorders (ROR = 17.06)], rucaparib [taste and smell disorders (ROR = 9.17)], niraparib [hematopoietic throbocytopenia (ROR = 28.2)], and talazoparib [hematopoietic erythropenia (ROR = 9.38)]. For AEs on the PT level, we found several significant signals, including platelet count decreased with niraparib (ROR = 52.78); red blood cell count decreased with niraparib (ROR = 70.47) and rucaparib (ROR = 15.09); myelodysplastic syndrome with olaparib (ROR = 35.47); acute myeloid leukaemia with olaparib (ROR = 25.14); blood pressure fluctuation with niraparib (ROR = 20.54); lymphangioleiomyomatosis with niraparib (ROR = 471.20); photosensitivity reaction with niraparib (ROR = 21.77) and rucaparib (ROR = 18.92); renal impairment with rucaparib (ROR = 33.32); and interstitial lung disease with Olaparib (ROR = 11.31). All the detected safety signals were confirmed using signals of disproportionality reporting methods. Conclusion : PARPis differed in their safety profile reports. The analysis of the FAERS database revealed significant safety signals that matched previously published case reports, including serious gastrointestinal, blood and lymphatic system, cardiovascular and respiratory complications, which require individualized drug administration according to patients’ conditions.

To examine the relationship between combined training and game loads and injury risk in elite Australian footballers. Prospective cohort study. Forty-six elite Australian footballers (mean±SD age of 22.2±2.9 y) from one club were involved in a one-season study. Training and game loads (session-RPE multiplied by duration in min) and injuries were recorded each time an athlete exerted an exercise load. Rolling weekly sums and week-to-week changes in load were then modelled against injury data using a logistic regression model. Odds ratios (OR) were reported against a reference group of the lowest training load range. Larger 1 weekly (>1750AU, OR=2.44–3.38), 2 weekly (>4000AU, OR=4.74) and previous to current week changes in load (>1250AU, OR=2.58) significantly related (p<0.05) to a larger injury risk throughout the in-season phase. Players with 2–3 and 4–6 years of experience had a significantly lower injury risk compared to 7+ years players (OR=0.22, OR=0.28) when the previous to current week change in load was more than 1000AU. No significant relationships were found between all derived load values and injury risk during the pre-season phase. In-season, as the amount of 1–2 weekly load or previous to current week increment in load increases, so does the risk of injury in elite Australian footballers. To reduce the risk of injury, derived training and game load values of weekly loads and previous week-to-week load changes should be individually monitored in elite Australian footballers.

The McDonald–Kreitman (MK) test is a simple and widely used test of selection in which the numbers of nonsilent and silent substitutions (Dn and Ds) are compared with the numbers of nonsilent and silent polymorphisms (Pn and Ps). The neutrality index (NI = DsPn/DnPs), the odds ratio (OR) of the MK table, measures the direction and degree of departure from neutral evolution. The mean of NI values across genes is often taken to summarize patterns of selection in a species. Here, we show that this leads to statistical bias in both simulated and real data to the extent that species, which show a pattern of adaptive evolution, can apparently be subject to weak purifying selection and vice versa. We show that this bias can be removed by using a variant of the Cochran—Mantel–Haenszel procedure for estimating a weighted average OR. We also show that several point estimators of NI are statistically biased even when cutoff values are employed. We therefore suggest that a new statistic be used to study patterns of selection when data are sparse, the direction of selection: DoS = Dn/(Dn + Ds) − Pn/(Pn + Ps).

Museums represent a fundamental asset for the Italian cultural and social background, and the use of digital technologies can be considered as a keystone for their attractiveness. Thus, assessing the specific determinants which stimulate to invest in new digital solutions and to provide a competitive museum offer is of crucial interest. For this reason, a performing multilevel approach for modeling the probability of including digital innovations in museums will be discussed and different modeling options will be compared. In particular, the implementation of a multilevel binary logit model will be useful to detect the factors of adopting at least basic digital tools. Then, the development of an innovative and flexible multilevel multinomial ordered model will be suitable to further investigate on the probability for the museums to move towards medium/low or high levels of digitalization, on the basis of an increasing sorting criterion. This will be realized by considering the variation of such probability both at regional and provincial levels for some key specific museums features, as well as by including some regional/provincial contextual factors.

Museums are extensively distributed all over the Italian territory. In this context, the identification of spatial patterns, referred to specific characteristics of museums evaluated at regional level, can support the enhancement of the cultural and natural heritage as well as the social and economic growth. In the literature, many studies were focused on the visitors’ profile or on the managerial performance and economic efficiency of the museums. However, none of them analysed the effects of the permanent presence of museums and their spatial contiguity by using both spatial machine learning models and statistical models. To this aim an innovative approach, which combines multilevel binary model and spatial clustering, as a machine learning unsupervised technique, is proposed to investigate the pattern recognition of the permanent museums all over the Italian territory and provide relevant information in terms of similarity among the spatial cluster formed. The logit of the museums to remain open all over the year, also with respect to different types of institution (private/public) and a different spatial/geographical constraints are jointly considered. In addition, a weight system is defined in order to introduce a regional measure of museums prevalence with respect to other types of cultural institutions. The ISTAT microdata concerning the Italian survey on museums and cultural entities are considered. The results highlight the great potentiality of this spatial clustering approach in delivering a better understanding of the role of museums as factor of challenge of urban development, providing in the meantime suggestions for tourism providers and museum managers.

Background Non-adherence to oral antidiabetic medications is a critical, multifactorial challenge that undermines disease management nationwide. This study aimed to determine the prevalence and predictors of non-adherence among patients with type 2 diabetes (T2DM) across Pakistan. We conducted a nationwide cross-sectional study between December 2023 and March 2025 in 225 healthcare facilities across all provinces of Pakistan. A total of 41,095 participants were selected using a multistage random sampling approach. Medication adherence was evaluated with self-reported pill counts and the Self-Efficacy for Appropriate Medication Use Scale (SEAMS). Multivariable logistic regression using a generalized linear model (GLM) logit approach was employed integrated with Interaction analysis to discover predictors of non-adherence. Result Non-adherence was present in 59.9% (n=24,616) of cases (n=24,616). Factors associated with reduced adherence included being female (AOR = 0.229, 95% CI: 0.067–0.779, P = 0.02), having only primary or secondary education (AOR = 0.186, 95% CI: 0.166–0.208, P < 0.001), absence of hospitalization, taking fewer medications per day, less frequent dosing schedules, and uncontrolled HbA1c levels. In contrast, factors linked to increased adherence were being married (AOR = 4.118, 95% CI: 3.611–4.695, P < 0.001), being a non-smoker (AOR = 12.98, 95% CI: 11.53–14.62, P < 0.001), having no family history of diabetes (AOR = 1.074, 95% CI: 1.021–1.129, P = 0.005), and having more than one comorbid condition. Conclusion Non-adherence to oral antidiabetic medication is prevalent and influenced by diverse personal, socioeconomic, and health-related factors. Targeted interventions addressing modifiable risk factors could improve adherence, ultimately reduce the healthcare burden and enhancing outcomes for patients with diabetes in Pakistan.